Scoring Instructions for NICHQ Vanderbilt Assessment Scales

CARING FOR CHILDREN WITH ADHD: A RESOURCE TOOLKIT FOR CLINICIANS, 2ND EDITION

Scoring Instructions for NICHQ Vanderbilt Assessment Scales

Baseline Assessment

The validation studies for the NICHQ Vanderbilt Assessment Scales were for the 6? to 12-year-old age group. However, to the extent that they collect information to establish Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, they are applicable to other groups, particularly preschoolers, where they have identified that DSM-5 criteria are still appropriate.

These scales should not be used alone to make a diagnosis of ADHD without confirming and elaborating the information with interviews with at least the primary caregivers (usually parents) and patients. You must take into consideration information from multiple sources. Scores of 2 or 3 on a single symptom question reflect often-occurring behaviors. Scores of 4 or 5 on performance questions reflect problems in performance.

The initial assessment scales, parent and teacher, have 2 components: symptom assessment and impairment in performance. On both parent and teacher initial scales, the symptom assessment screens for symptoms that meet criteria for inattentive (items 1??9) and hyperactive (items 10??18) attention-deficit/hyperactivity disorder (ADHD).

Scoring for Diagnostic Purposes To meet DSM-5 criteria for the diagnosis, one must have at least 6 positive responses to the inattentive 9 or hyperactive 9 core symptoms, or both. A positive response is a 2 or 3 (often, very often) (you could draw a line straight down the page and count the positive answers in each subsegment). There is a place to record the number of positives in each subsegment.

The initial scales have symptom screens for 3 other comorbidities: oppositional-defiant disorder, conduct disorder, and anxiety/ depression. (The initial teacher scale also screens for learning disabilities.) These are screened by the number of positive responses in each of the segments. The specific item sets and numbers of positives required for each comorbid symptom screen set are detailed below and on the next page.

The second section of the scale has a set of performance measures, scored 1 to 5, with 4 and 5 being somewhat of a problem/ problematic. To meet criteria for ADHD there must be at least 2 items of the performance set in which the child scores a 4, or 1 item of the performance set in which the child scores a 5; ie, there must be impairment, not just symptoms, to meet diagnostic criteria. The sheet has a place to record the number of positives (4s, 5s).

Scoring to Monitor Symptom and Performance Improvement For the purposes of tracking symptoms and symptom severity, calculate the mean response for each subsegment of the ADHD symptom assessment screen items (inattentive 9 and hyperactive 9). To calculate the mean responses, first total the responses (0s, 1s, 2s, and 3s) from each item within the inattentive subsegment (items 1??9) and divide by the number of items that received a response. For example, if a parent only provided responses to 7 of the first 9 items, the responses would be totaled and divided by 7. Follow the same calculation instructions for the hyperactive subsegment (items 10??18).

Parent Assessment Scale

?Predominantly Inattentive subtype Must score a 2 or 3 on 6 out of 9 items on questions 1??9.

? AND Score a 4 on at least 2, or 5 on at least 1, of the performance questions 48??54.

?Predominantly Hyperactive/Impulsive subtype Must score a 2 or 3 on 6 out of 9 items on questions 10??18.

? AND Score a 4 on at least 2, or 5 on at least 1, of the performance questions 48??54.

?ADHD Combined Inattention/Hyperactivity Requires the criteria on Inattentive AND Hyperactive/Impulsive subtypes

?Oppositional-Defiant Disorder Must score a 2 or 3 on 4 out of 8 behaviors on questions 19??26.

? AND Score a 4 on at least 2, or 5 on at least 1, of the performance questions 48??54.

?Conduct Disorder Must score a 2 or 3 on 3 out of 14 behaviors on questions 27??40.

? AND Score a 4 on at least 2, or 5 on at least 1, of the performance questions 48??54.

Teacher Assessment Scale

?Predominantly Inattentive subtype Must score a 2 or 3 on 6 out of 9 items on questions 1??9.

? AND Score a 4 on at least 2, or 5 on at least 1, of the performance questions 36??43.

?Predominantly Hyperactive/Impulsive subtype Must score a 2 or 3 on 6 out of 9 items on questions 10??18.

? AND Score a 4 on at least 2, or 5 on at least 1, of the performance questions 36??43.

?ADHD Combined Inattention/Hyperactivity Requires the criteria on Inattentive AND Hyperactive/Impulsive subtypes

?Oppositional-Defiant/Conduct Disorder Must score a 2 or 3 on 3 out of 10 items on questions 19??28.

? AND Score a 4 on at least 2, or 5 on at least 1, of the performance questions 36??43.

ASSESSMENT AND DIAGNOSIS

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Scoring Instructions for NICHQ Vanderbilt Assessment Scales

Parent Assessment Scale

?Anxiety/Depression Must score a 2 or 3 on 3 out of 7 behaviors on questions 41??47.

? AND Score a 4 on at least 2, or 5 on at least 1, of the performance questions 48??54.

Follow-up Assessment

Scoring for Diagnostic Purposes The parent and teacher follow-up scales have the first 18 core ADHD symptoms and the comorbid symptoms oppositional-defiant (parent) and oppositional-defiant/conduct (teacher) disorders. The Performance section has the same performance items and impairment assessment as the initial scales; it is followed by a sideeffect reporting scale that can be used to assess and monitor the presence of adverse reactions to prescribed medications, if any. Scoring the follow-up scales involves tracking inattentive (items 1??9) and hyperactive (items 10??18) ADHD, as well as the

Parent Assessment Scale

?Predominantly Inattentive subtype Must score a 2 or 3 on 6 out of 9 items on questions 1??9.

? AND Score a 4 on at least 2, or 5 on at least 1, of the performance questions 27??33.

?Predominantly Hyperactive/Impulsive subtype Must score a 2 or 3 on 6 out of 9 items on questions 10??18.

? AND Score a 4 on at least 2, or 5 on at least 1, of the performance questions 27??33.

?ADHD Combined Inattention/Hyperactivity Requires the criteria on Inattentive AND Hyperactive/Impulsive subtypes

?Oppositional-Defiant Disorder Must score a 2 or 3 on 4 out of 8 behaviors on questions 19??26.

? AND Score a 4 on at least 2, or 5 on at least 1, of the performance questions 27??33.

Teacher Assessment Scale

?Anxiety/Depression Must score a 2 or 3 on 3 out of 7 items on questions 29??35.

? AND Score a 4 on at least 2, or 5 on at least 1, of the performance questions 36??43.

?Learning Disabilities Must score a 4 on both, or 5 on 1, of questions 36 and 38.

aforementioned comorbidities, as measures of improvement over time with treatment.

Scoring to Monitor Symptom and Performance Improvement To determine the score for follow-up, calculate the mean response for each of the ADHD subsegments. Compare the mean response from the follow-up inattentive subsegment (items 1??9) to the mean response from the inattentive subsegment that was calculated at baseline assessment. Conduct the same comparison for the mean responses for the hyperactive subsegment (items 10??18) taken at follow-up and baseline.

Teacher Assessment Scale

?Predominantly Inattentive subtype Must score a 2 or 3 on 6 out of 9 items on questions 1??9.

? AND Score a 4 on at least 2, or 5 on at least 1, of the performance questions 29??36.

?Predominantly Hyperactive/Impulsive subtype Must score a 2 or 3 on 6 out of 9 items on questions 10??18.

? AND Score a 4 on at least 2, or 5 on at least 1, of the performance questions 29??36.

?ADHD Combined Inattention/Hyperactivity Requires the criteria on Inattentive AND Hyperactive/Impulsive subtypes

?Oppositional-Defiant/Conduct Disorder Must score a 2 or 3 on 3 out of 10 items on questions 19??28.

? AND Score a 4 on at least 2, or 5 on at least 1, of the performance questions 29??36.

The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. Original document included as part of Caring for Children With ADHD: A Resource Toolkit for Clinicians, 2nd Edition. Copyright ? 2012 American Academy of Pediatrics, Updated August 2014. All Rights Reserved. The American Academy of Pediatrics does not review or endorse any modifications made to this document and in no event shall the AAP be liable for any such changes.

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